Question 1

What is HCPCS code C9816?

Accepted Answer

HCPCS code C9816 is "Pmp prs reusbl nonopioid dev". Rotary peristaltic infusion pump (e.g., reusable ambit pump) including all disposable system components, reusable non-opioid medical device (must be a qualifying medicare non-opioid medical device for post-surgical pain relief in accordance with section 4135 of the caa, 2023)

Question 2

What category is C9816 in?

Accepted Answer

C9816 belongs to HCPCS Category C (CMS Hospital Outpatient Payment).

Question 3

When should I use HCPCS code C9816?

Accepted Answer

Use C9816 when billing for pmp prs reusbl nonopioid dev. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is C9816 covered by Medicare?

Accepted Answer

Coverage for C9816 (Pmp prs reusbl nonopioid dev) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for C9816?

Accepted Answer

Documentation for C9816 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).